Report: Miami-Dade to face tough choices as federal funding for uninsured dwindles

Florida legislators, meeting this month in Tallahassee, are looking down the barrel of a healthcare financial crisis for the second consecutive year — and once again, Miami-Dade, home to the state’s largest number of uninsured residents and its busiest public hospital, Jackson Health System, stands to lose more than any other county, according to a report released Wednesday.

In the report, Florida Legal Services, a nonprofit advocate of expanding coverage through the Affordable Care Act, sounds an alarm about a confluence of state and federal health policy decisions that are likely to strain the healthcare safety net, forcing local hospitals to compete for a dwindling pot of money and to make difficult choices about how to best meet the needs of the uninsured.

“This is something that counties cannot ignore,” said Miriam Harmatz, a senior health law attorney for Florida Legal and co-author of the report. “If you are low income and uninsured, you never had an easy time accessing the safety net, even at the height of [federal and state] funding, and now it’s going to be much, much harder.”

At stake is the ability for hospitals to support charity care programs that provide free or reduced-price healthcare to low-income, uninsured residents.

The report addresses Florida’s refusal to expand eligibility for Medicaid to nearly all low-income adults, as provided for under the health law, and the impacts of that decision on the state’s economy and on the estimated 567,000 uninsured residents statewide who would gain coverage under expansion.

Last year’s debate over a proposal for Medicaid expansion, which the Senate supported but the House and Gov. Rick Scott opposed, created a deadlock that led the Legislature to end abruptly and forced lawmakers to reconvene months later to adopt a state budget.

This week, Florida Sen. Don Gaetz, a Republican and former Senate president, called Medicaid expansion “dead” in the Legislature.

But the majority of Florida Legal’s report focuses on the Obama administration’s planned reductions to public programs, such as the Low Income Pool, that pay hospitals for care they’ve provided to the uninsured, mostly through emergency rooms.

The largest of these programs, LIP is scheduled to drop from $1 billion for the year ending June 30 to about $608 million the following year — a nearly 75 percent reduction from the program’s height of $2.1 billion in statewide hospital funding in 2014-15.

According to the report, Jackson Health receives the largest amount of LIP funding in part because Miami-Dade sends more local taxes than any other county in Florida to draw federal matching dollars.

In 2015-16, Miami-Dade will send about $217 million in local taxes, and should receive about $285 million in return after the federal match. That money will be distributed among local hospitals, including about $250 million for Jackson Health, about $15 million for University of Miami Hospital and its clinics, and about $8.7 million for Mount Sinai Medical Center in Miami Beach.

For 2016-17, however, the Obama administration reduced the amount of local taxes that can qualify for federal match under LIP, capping Miami-Dade’s contribution at about $61 million, which according to the report will result in an estimated $140 million return for all local hospitals.

The distribution of that money is still in question, especially since federal officials say the money can only be used for charity care.

Jennifer Piedra, a Jackson Health spokeswoman, said in a written statement that any reduction in LIP would hurt uninsured patients.

“We cannot overstate the impact that a potential $52 million LIP funding cut will have on our community and on the ability of safety-net hospitals like Jackson to provide care for uninsured and under-insured patients,” she said.

Other local hospitals with large numbers of uninsured patients, such as the nonprofit Baptist Health System’s Homestead Hospital, might receive more than they have in the past.

That’s cold comfort, said Wayne Brackin, chief operating officer for Baptist Health.

“The tragedy of the circumstance,” he said, “is that what people need — more importantly than having some of their bills paid indirectly through LIP funding — is access to coverage that starts to move them away from the emergency department and into … more appropriate settings where they can get routine care.”

This story was originally published January 20, 2016 at 6:35 PM with the headline "Report: Miami-Dade to face tough choices as federal funding for uninsured dwindles."